Large Research Studies

1393532 - Mid-term outcomes in COVID Vaccination-Associated Myocarditis: Preliminary Results from the Multicenter MACiV (Myocarditis After COVID Vaccination) Study

Friday, January 27, 2023

2:55 PM – 3:10 PM

Location: Silver Pearl 3

Presenting Author(s)

Supriya S. Jain, MD, FSCMR

Director, Pediatric Cardiac MR/Advanced CV Imaging, Associate Professor of Pediatrics and Radiology
New York Medical College-Maria Fareri Children's Hospital at Westchester Medical Center
Valhalla, New York, United States

Primary Author(s)

Supriya S. Jain, MD, FSCMR

Director, Pediatric Cardiac MR/Advanced CV Imaging, Associate Professor of Pediatrics and Radiology
New York Medical College-Maria Fareri Children's Hospital at Westchester Medical Center
Valhalla, New York, United States

Co-Author(s)

JS

Jeremy M. Steele, MD

Assistant Professor of Pediatrics and Radiology and Biomedical Imaging
Yale University
Guilford, Connecticut, United States
JM

JuanCarlos Muniz, MD

Director, NonInvasive Imaging
NIcklaus Children's Hostpital, United States
JS

Jonathan H. Soslow, MD, MSc

Associate Professor of Pediatrics, and Director, Pediatric Cardiac Imaging Research Center
Vanderbilt University Medical Center
Nashville, United States
MD

Matthew L. Dove, MD

Pediatric Cardiology Fellow
Emory University
Atlanta, Georgia, United States
OF

Olivia Frosch, MD

Pediatric Cardiology Fellow
University of Michigan
Ann Arbor, Michigan, United States
Brian Fonseca, MD

Associate Professor of Cardiology
Children's Hospital Colorado
Aurora, Colorado, United States
Sujatha Buddhe, MD, MSc

Director, Noninvasive Cardiac Imaging Research
Seattle Children's Hospital
Seattle, Washington, United States
DT

Deepika Thacker, MD

Associate Professor
Nemours Childrens Health Delaware
Wilmington, Delaware, United States
SS

Saira Siddiqui, MD

Pediatric Cardiologist, Assistant Professor of Pediatrics
Morristown Medical Center, United States
JK

Jared D. Klein, MD, MPH

Pediatric Cardiology Imaging Specialist
Joe DiMaggio Children's Hospital
Fort Lauderdale, Florida, United States
AV

Aswathy Vaikom House, MD

Assistant Professor
Oklahoma Children's Hospital
Oklahoma City, Oklahoma, United States
AC

Andrew L. Cheng, MD

Assistant Professor of Clinical Pediatrics
Children’s Hospital Los Angeles
Los Angeles, California, United States
JS

Jennifer A. Su, MD

Assistant Professor of Clinical Pediatrics
Children's Hospital Los Angeles
Los Angeles, California, United States
MS

Madhu Sharma, MD

Assistant Professor, Albert Einstein College of Medicine
The Children's Hospital at Montefiore
Tenafly, New Jersey, United States
AH

Ashraf S. Harahsheh, MD

Associate Professor of Pediatrics
Children's National Medical Center
Washington, District of Columbia, United States
LN

Lakshmi Nagaraju, MD

Assistant Professor
UC Davis Children’s Hospital, United States
MC

Matthew Cornicelli, MD

Assistant Professor of Pediatrics
Ann & Robert H. Lurie Children's Hospital of Chicago, United States
PR

Preeti Ramachandran, MD

Assistant Professor of Pediatric Cardiology
University of Kentucky, Kentucky, United States
FH

Frank Y. Han, MD

Pediatric Cardiologist
UIC
Gainesville, Florida, United States
SU

Santosh C. Uppu, MD

Associate Professor
The University of Texas Health Science Center at Houston, Texas, United States
JP

Jyoti K. Patel, MD

Assistant Professor of Pediatrics
Riley Children's Health
Indianapolis, Indiana, United States
MB

Michael Brumund, MD

Dr.
Children's Hospital New Orleans, United States
PE

Parham Eshtehardi, MD

Cardiologist
Northside Heart Institute, United States
Lars Grosse-Wortmann, M.D., FRCPC, MD

Dr.
Oregon Health & Science University
Portland, Oregon, United States

Disclosure(s):

Supriya S. Jain, MD, FSCMR: No financial relationships to disclose

Background:

Immunization has been a public health cornerstone in the mitigation of the SARS-CoV-2 pandemic. COVID vaccine-associated myocarditis (C-VAM) is a rare complication of mRNA vaccines.^1-4 Using cardiovascular magnetic resonance (CMR) imaging, we found a nearly ubiquitous presence of myocardial tissue scarring and inflammation in children with C-VAM.⁴ The prognostic implications and clinical significance of myocardial tissue damage in this population are unknown. The aims of the current study were to understand the mid-term outcomes of C-VAM and to characterize its acute presentation in contrast to multi-system inflammatory syndrome in children (MIS-C) secondary to COVID, one of the conditions that immunizations aim to prevent.

Methods:

A large multicenter retrospective observational study, endorsed by SCMR, was conducted, majority of co-investigators being SCMR members. Patients ≤30 years of age with a diagnosis of acute myocarditis, based on clinical presentation, abnormal biomarkers and/or cardiovascular imaging findings following COVID-19 vaccination were included and compared to patients with MIS-C who had CMR during their acute/sub-acute phase of illness.

Results:

Initial data analysis was done on 264 patients from 24 institutions, including 225 patients with C-VAM, mean age of 16 years (5-29 years). Patients’ demographics and clinical presentation details are summarized in Table 1. 207 (92%) of the patients received the Pfizer vaccine, 185 (82%) presented following the 2nd dose, 24 (11%) after the 1st dose, and 13 (6%) after the 3rd dose (booster). C-VAM patients were older (16±2 vs. 12±5, p< 0.0001) and included a lower proportion with reduced LV EF in comparison to the MIS-C cohort (24% vs. 82%, p=< 0.0001). Two percent required inotropic support and extracorporeal membrane oxygenation was used in 1 patient, in contrast to the MIS-C cohort in whom this was required in 72% and 5%, respectively. Late gadolinium enhancement (LGE) was prevalent in C-VAM (85% vs. 18%, p < 0.05), Figure 1. Younger patients with C-VAM (< 15 years of age) were less likely to exhibit LGE (74% vs. 89%, p=0.04) or decreased LV EF (13% vs. 29%, p=0.01). Follow-up information in 158 C-VAM patients, ranged from 7-476 days. No patient died or was listed for heart transplantation. Two patients were readmitted, one for recurrent myopericarditis and the other for ventricular tachycardia. Arrhythmias remained rare, affecting 4% of the patients during follow-up. LGE decreased in prevalence between the initial presentation and follow-up but remained common at 67%

Conclusion:

Myocardial injury as confirmed by CMR is common in C-VAM. LGE persisted in two thirds of the C-VAM patients during their follow-up visits. Reassuringly, at the mid-term mark, no ventricular remodeling, marked by left ventricular dilation was present. No deaths or need for heart transplantation occurred. Further data analysis on >400 patients from >35 sites is pending, we will have more detailed information at the time of SCMR 2023.